Author: Hospicare

How to Talk to Your Proxy About Your Advanced Care Wishes

Posted on by Hospicare

By Jane Baker Segelken, MA, MSW, and part of the Social Work team at Hospicare & Palliative Care Services

Jane Segelken, MA, MSW

One thing that’s important to remember when thinking about advanced care planning is that it’s not just about end of life. In reality, it’s about how you’re living now. It’s about making sure everyone is ready to make decisions on your behalf when you’re unable to communicate — even temporarily while you’re recovering from an accident, surgery, or debilitating illness.

Several years ago, 83-year-old Ella fell and severely broke her shoulder. In the hospital and loaded up on pain medication, the usually cognitively sharp Ella was unable to think clearly. She couldn’t understand the surgical options being presented to her and couldn’t communicate which surgery she preferred. Fortunately, she had talked to her legally appointed health care proxy about many different things including how important quality of life was to her. That information, including knowing something about Ella’s hobbies and interests, allowed her agent to advocate for an extensive surgery that allowed Ella to resume all her activities, including driving. Had the proxy not been informed and kept up to date on Ella’s wishes as they evolved, the proxy might have allowed the physicians to perform a lesser surgery that would have severely limited the very active Ella’s independence.

There is no question conversations about our advanced care wishes are hard. Making decisions about future scenarios isn’t easy. It’s scary for us to think about our own misery and it’s daunting for our proxy to consider our suffering. But the talks are totally worth it. In fact, doing so will minimize our distress and give our agent the confidence they are making the right decisions — some of the hardest he or she will ever have to do.

Once you’ve identified the person you want to represent your wishes — someone who can make difficult decisions, can advocate for you, and who knows your values — it’s time to have “The Talk.”

Talking about your advanced care wishes

There is never the perfect moment to begin the conversation. And it may happen over time — in several conversations rather than one. But a good way to start with the person you’ve selected as your agent is to frame it by saying, “I’d like to talk to you about how I want to live.”

  1. Be direct.
  2. Talk about a situation that someone else, such as a friend or relative, has experienced.
  3. Speak about your values — what makes your life worth living?
  4. Discuss what brings you comfort and joy — your interests, likes, and dislikes.
  5. Talk about what health, sickness, and death mean to you.
  6. Talk about pain. Do you want to be able to communicate while being treated for pain even if it means you might still be uncomfortable? Or would you rather be sedated and pain free?
  7. Consider life support treatments and reveal where your views on them come from. Share under what situations you would want to be on life support — such as a device to help you breathe, nutrition and hydration through a tube, CPR, etc. — and when you might want nothing to be done.
  8. Make sure to address your religious beliefs, if any, regarding healthcare decisions.

Part of this discussion should also address care at the end of your life. Things to consider include:

  1. Do you want a religious or spiritual leader to visit with you?
  2. Do you want music, candles, incense, and dim/bright light in the room? Specify the kind of music you like, the candle/incense aroma, and whether the light should be natural or artificial.
  3. Do you want to know when death is approaching so you can tie up loose ends and say goodbye to friends and family?
  4. Where do you want to die (hospital, hospice residence, at home, other)?
  5. Do you want to donate your organs? Are there any limitations?

As time goes by, especially if your health changes, review your advanced care planning wishes. When you’re young, every 10 years is a good benchmark. As you get older you may want to reevaluate even more frequently. Make sure your proxy, family, close friends, and your doctor know of any changes in your preferences.

Resources

The planning you do now will be a gift to your proxy, to those in your life to whom you matter, and to yourself.

Join Dr. Lucia Jander and the Hospicare & Palliative Care Services’ interdisciplinary team on March 15, from 5:30-7 for a webinar, Having the Conversations & Organizing Your Info.  To register email jennifer@crcfl.net or call 607-272-0212.

*Jane Baker Segelken, MA, MSW, is part of the Social Work team at Hospicare & Palliative Care Services.

How Patients’ Wishes Can Guide Medical Decision Making

Posted on by Hospicare

By Jane Baker Segelken, MA, MSW, and part of the Social Work team at Hospicare & Palliative Care Services

Jane Segelken, MA, MSW

With the new year upon us, one of the kindest favors we can give the important people in our lives is information on the kind of care we wish to receive if we become ill or incapacitated. Letting them know our care plans and wishes in advance is a true act of love. Doing so takes away some of the burden and stress by allowing them to focus on us without the preoccupation of making decisions we haven’t discussed with them.

For anyone over the age of 18, advanced care planning is the process that allows us to make decisions about our future health care. It is a way of providing guidance for decisions that may have to be made when we are unable to make and/or communicate them on our own. The preferences are noted on legally recognized documents; then the choices are communicated to family/friends and health care providers who are appointed to be the decisionmakers.

While we often think about advanced care planning as part of end of life, there are times when you might be unable to make decisions because you are taking medications that make you fuzzy headed or are in severe pain that prevents you from being able to focus. Regardless of whether you are needing someone to assist in an emergency or at the end of life, having someone who knows your wishes almost guarantees you’ll be treated the way you want. Without these legal documents, decisions about your care may be made by healthcare providers who know nothing about your values.

Medical Decisions: Choosing Your Proxy and Talking About Your Wishes

When thinking about who you will have as your proxy, also known as an agent, it’s important to select someone who will honor your wishes. While many people choose a partner/spouse or child, they may not be the best ones to make the difficult decisions. What is key is that the proxy be able to determine the kind of care you receive based on your wishes not theirs. Others who can act on your behalf include a friend, lawyer, or someone in your social or spiritual community. Also, name an alternate proxy. Be sure to ask the people you want to appoint as your agents in advance to ensure they are comfortable with the process.

Make sure you have a deep, detailed, and honest conversation with your appointed agents about how you want to be cared for in a medical emergency or at the end of life. Talk about your thoughts, beliefs, and values so your agent can make the kind of decisions you would if you were able. It’s also important to talk about your decisions with your loved ones and your physicians so they can partner with your proxy. The Five Wishes and My Living Voice programs are two excellent resources to help guide you through the process.

Medical Decisions: The Documents

  • A Health Care Proxy is a legal document that designates the person who will make health care decisions only if you are unable to make them yourself. Because it is difficult to know all the choices that will need to be made, it is important to appoint someone you trust and who knows your core values; make sure he or she hears details about your wishes that go beyond what you have written on the proxy form. Keep the original at home; give copy of the completed document to your appointed agent (proxy), your alternate agent, your primary medical providers, and your attorney if you have one. While some people also prepare a Living Will, it’s important to remember that is not a legal document.
  • A Medical Orders for Life Sustaining Treatment (MOLST) form outlines your wishes for the end of life in the event you cannot make this decision yourself. This form is filled out with and signed by your physician and reviewed at least every 90 days. If you do not have a proxy, the MOLST will guide medical decisions. If you do have a proxy, this document can guide their choices on your behalf.
  • A Do Not Resuscitate Order (DNR) determines what life sustaining measures, if any, you would like if your heart has stopped beating and you are not breathing. While a DNR can stand alone, it is also a part of the more comprehensive MOLST form.

Resources

If you need help connecting to resources, or ideas for how to start this process, please contact Hospicare & Palliative Care Services at 607-272-0212 with any questions or visit their website at hospicare.org.

*This article originally appeared in the Cortland Standard on January 27, 2022, as the first of a 12 column series devoted to topics relating to hospice and Hospicare called “Let’s Talk Hospice”.

UPCOMING ADVANCED CARE PLANNING EVENT

Having the Conversations & Organizing Your Info
March 15, 5:30 – 7:00 pm via Zoom

For help with advanced care planning, attend Having the Conversations & Organizing Your Info, an upcoming webinar with Dr. Lucia Jander and the Hospicare & Palliative Care Services’ interdisciplinary team and hosted by the Cancer Resource Center. For more information about this and other event, visit our event calendar.

Recovering Your Creative Spirit in Grief

Posted on by Hospicare

by Brenna Fitzgerald writer, editor, coach, and host of Creative Recovery podcast

Grief is a process that may involve conflicting emotions and can often feel uncomfortable and confusing. It’s natural to want to close down, shut off, and stop this unpredictable flow, especially in a society that expects grieving to happen in a certain linear timeframe and pathologizes anything outside of that.

Brenna Fitzgerald

I recently listened to an interview with grieving expert David Kessler, author of Finding Meaning: The Sixth Stage of Grief. He talked about the desire grieving individuals may feel to make the grief smaller in some way and offered an insightful alternative perspective to this reaction. “Rather than make the grief smaller,” he said, “we need to make ourselves bigger. Grief is love, and we don’t want it to get smaller.” He calls for a transformation of the traumatic wound into the cherished wound.

Indeed, research on grief supports Kessler’s emphasize on the importance of making space for grieving in all its forms. In his book The Wild Edge of Sorrow, psychotherapist Francis Weller writes, “if we ignore the fire, our internal life feels cold and the grief in our container congeals. Offering our attention, affection, and love, on the other hand, feeds the fire, and the gradual work of transmuting grief into gold can commence.”

My own early struggles with depression and an eating disorder as a teenager offered a gateway into investigating grief. Of course, I didn’t know it at the time, so consumed by my own suffering and unprocessed loss. It was not until I had undergone years of therapy in various forms from cognitive therapy to meditation and mindfulness practices to restorative yoga and creative writing that a deeper understanding of my inner world awakened. I realized that my depression and eating disorder were manifestations of stuck energy—of grief—from having experienced trauma in my early years and not having had the tools to process it. I began to realize the importance of practices, and especially practices of creative expression, to help move the complex energies stirred by my losses.

As Weller writes, “we are a menagerie of moods, emotions, thoughts, and selves. For the most part, we keep the unsavory brothers and sisters on the outskirts of town. Practice, however, invites these voices into the mix, recognizing in them an essential element in our well-being. We are asked to welcome the weak and vulnerable parts of ourselves in times of grieving….” I love his perspective and the emphasis on practice as an invitation into such a compassionate view of our grief.

It is through this lens that I created my upcoming workshop “Recovering Your Creative Spirit in Grief.” Grief can cause you to feel stuck, uninspired, and unfulfilled. This impacts your ability to express conflicting emotions in creative ways. In this workshop we will explore the feeling of being stuck and how it affects our inner life and outer expression. Through written reflection, group discussion, mind-body practices, and intuitive collage I will guide participants into a deeper understanding of their own blocks. Together we will create a safe and supportive container for each person to begin the process of shifting from stuck to unstuck. My intention is to facilitate awareness of and curiosity around the needs and desires of your creative spirit and to share tools and practices to help you sustain a nourishing and fulfilling engagement in life well beyond the workshop.

David Kessler says that “each person’s grief is as unique as their fingerprint. But what everyone has in common is that no matter how they grieve, they share a need for their grief to be witnessed.” Research on grief conducted by Robert A. Neimeyer, a psychology professor at the University of Memphis and a clinician, points to this same insight of the need for connection in healing. Great strength, resiliency, and compassion emerge when we can be present to our own self-expression and the self-expression of others, whether in the form of sharing stories around a fire or making collage on zoom.

This workshop is an opportunity for us to come together in community and offer space for one another’s stuck energy to flow in creative ways. May the practices we play with help you connect to a much larger sense of yourself and the world—a self that can hold, in love, the pain of your loss. As one of my favorite writers and thinkers, Audre Lorde, says: “These places of possibility within ourselves are dark because they are ancient and hidden; they have survived and grown strong through darkness. Within these deep places, each one of us holds an incredible reserve of creativity and power, of unexamined and unrecorded emotion and feeling.” I look forward to sharing healing creative space with you at “Recovering your Creative Spirit in Grief” offered virtually through Hospicare on March 3, 2022, from 6:30-8:00 p.m. May we all exceed the limits of our own self-image and awaken to the expansive being within—our inner creator.

EVENT INFORMATION

Recovering Your Creative Spirit in Grief
March 03, 6:30 – 8:00 pm via Zoom

To participate in this event, REGISTER HERE by February 28th. 

To learn about other events offered by Hospicare & Palliative Care Services, visit the events calendar on our website.

Training the Next Generation of Hospice-Minded Doctors

Posted on by Hospicare

My name is Dr. Lucia Jander. I am the medical director for Hospicare & Palliative Care Services. You may know that Hospicare provides hospice, palliative care, and grief support to people living in Cortland and Tompkins counties, but did you know that we also recently started a new program training medical residents?

Since May of 2021, Hospicare has been working with Dr. Janette Lee of Cayuga Medical Center (CMC) to train a new generation of doctors in the Internal Medicine Residency program. These young doctors are doing their Geriatric Rotation at Hospicare.

Dr. Lucia Jander speaks with Dr. Priyesh Thakurathi, a CMC resident participating in the Geriatric Rotation at Hospicare.

My own professional interest in hospice came from an elective rotation in my residency. There is no formal requirement to have a hospice experience, but clearly it is very helpful for future internists in the community to understand these issues.

Let me explain the difference between hospice and palliative care: Hospice is a subset of palliative care for people who are at the end of life, generally with a 6-month prognosis. Palliative care can be delivered for several years before patients qualify for hospice. It is a special care for people with severe and chronic illnesses and can be given concurrently with curative care. The goal of palliative care is to help with symptom management, allow for open communication, and improve a patient’s quality of life.

During this semester-long rotation, CMC residents spend time in a long-term care facility, perform home hospice visits, come to our hospice residence, and are introduced to working in an interdisciplinary health care team. The goal of the rotation is to develop knowledge, skills, and the interpersonal communication needed to provide effective and compassionate care to patients receiving our services. Residents gain a broader understanding of the difference between hospice and palliative care.

During the Geriatric Rotation, CMC residents learn ways to help patients stay at home, improve their quality of life, and help them understand their illness, which may result in decreased hospitalizations or trips to the emergency room. I think it is important to remind trainees that 99% of patients’ lives are spent outside of the hospital; this may seem an obvious statement, but when residents are in the middle of their training, they are seeing the worst 1% of people’s lives when they are in crisis-medical misery. My hope is that the outpatient geriatric rotation helps CMC resident’s understand what matters most to their geriatric patients and ways to improve their quality of life.

Dr. Priyesh Thakurathi, a CMC resident meets with a patient at the Hospicare residence.

My primary goals are to teach trainees to understand their patients’ priorities (which may be vastly different from the healthcare team’s priorities) and help them recognize how much social factors influence patients’ lives – much more than our medical interventions.

CMC residents become incorporated into the Hospicare team. They join our nurses and social workers on their workday. The more exposure they have to Hospicare, the higher likelihood they will appreciate the help hospice provides for their patients, give prompt referrals for those who will benefit from hospice and palliative services, and stay in the community as primary care practitioners starting next July.

We are very glad to be able to train the next generation of doctors!

Why I Work in Hospice (Part 5) – Sarah Nickerson, Communications Coordinator

Posted on by Hospicare

A Special Blog Series Written by Hospicare & Palliative Care Services Staff

This November, we started a special blog series written by Hospicare staff in honor of National Hospice and Palliative Care Month. Because we had such a positive response to the series, we are continuing it past November and into 2022. Each post features a different member of our staff as they share why they love the work they do. In part five of this series, we feature Sarah Nickerson, Hospicare Communications Coordinator.

Sarah Nickerson, Hospicare Communications Coordinator

“Hi, my name is Sarah Nickerson, and I am Hospicare’s new communications coordinator. I spent the summer helping Hospicare’s development team with Women Swimmin’ as the seasonal events assistant, and was hired into my current role by Sara Worden, director of development and community relations, in November. I am so excited to take on this role and help share the amazing work our team does and stories of the people we serve!

My relationship with Hospicare began many years ago. In my early twenties, I accompanied my mother, who was a Hospicare volunteer, to a bereavement group for children held at the residence on Kind Road. A few years later, I proudly waited on shore while she swam across Cayuga Lake as a participant in Women Swimmin’ for Hospicare. In the summer of 2018, my mother was diagnosed with a terminal brain tumor and given less than a year to live. We were fortunate enough to be able to move her into Hospicare’s residence for the final months of her life. Having my mother in care at the residence allowed us to be with her as loved ones and not caretakers, which we were ill equipped to be. Hospicare became a home away from home in those last two months before my mother’s death: a safe space filled with love, where I could be nurtured by community.

The amazing care that was given to my mother and to our entire family by Hospicare’s staff stays with me and is why I am so honored to be part of this team today. I look forward to continuing to help Hospicare provide our community with compassionate end-of-life care and grief support.”

I took this photo of my father holding my mother’s hand while she was in care in the residence at King Road just a few weeks before her death on Valentine’s Day of 2019.

***If you have a hospice or Hospicare story you want to share, please email Sarah Nickerson at snickerson@hospicare.org for more information or send a letter to:

Hospicare & Palliative Care Services

Attn: Sarah Nickerson

172 East King Rd

Ithaca, NY 14850

Why I Work in Hospice (Part 4) – Anna Osterhoudt, Social Worker

Posted on by Hospicare

A Special Blog Series in Honor of National Hospice and Palliative Care Month

This November, we are sharing a special blog series written by Hospicare staff in honor of National Hospice and Palliative Care Month. Each post will feature a different member of our staff as they share why they love the work they do. In part four of this series, we feature Anna Osterhoudt, Hospicare Social Worker.

Anna Osterhoudt, Hospicare Social Worker

“My name is Anna, and I am one of three social workers that are a part of the Hospicare team. My role as a hospice social worker is to assess the needs of our patients, their families, and support systems and provide any assistance I can. A few examples of things that I may assist with are providing emotional support to patients/caregivers, connecting them with community resources, assisting with end-of-life planning, or just being a friendly face during what can be a very difficult time.

I have been working professionally as a social worker in the medical field for the last eight years. However, I only recently joined Hospicare & Palliative Care Services three months ago. Making the decision to join Hospicare was not a difficult one as I have grown to be very passionate about hospice work, both professionally and personally. It is truly an honor and a blessing to be on this journey and to be a part of someone’s final chapters on this earth. 

With the right support, death and dying can be a spiritual, dignified, and peaceful experience. To be able to be a part of that experience and offer support and solace to patients, caregivers, and families during that time is a privilege that I cherish. It can also be scary, emotional, and trying but what is so special about Hospicare is that no matter what the experience is, which is very different for everyone, we are never alone. As a team we support each other, the patients, their families and caregivers, other agency staff, you name it, we are never left to handle it alone.  So why did I choose to work in hospice? There is a saying ‘Find a job you love, and you’ll never work a day in your life.’ I was lucky enough to find that job with Hospicare.”

Why I Work in Hospice (Part 3) – Wendy Yettru, Manager of Volunteer Services

Posted on by Hospicare

A Special Blog Series in Honor of National Hospice and Palliative Care Month

This November, we are sharing a special blog series written by Hospicare staff in honor of National Hospice and Palliative Care Month. Each post will feature a different member of our staff as they share why they love the work they do. In part three of this series, we feature Wendy Yettru, Manager of Volunteer Services.

Wendy Yettru, Manager of Volunteer Services

“Hi, my name is Wendy and I’m the Manager of Volunteer Services at Hospicare & Palliative Care Services. When I started working here, over 20 years ago, I didn’t know much about hospice. It didn’t take long for me to see firsthand how the amazing team of professionals, including our volunteers, provides comfort physically, emotionally, and spiritually for our patients and their families. I believe in the philosophy that hospice is there so that patients may live as fully and comfortably as possible while facing end of life.

My position allows me the privilege of educating and working with community members who want to give their time and talents to Hospicare. I have enjoyed getting to know hundreds of people in Cortland and Tompkins counties as they learn about hospice and how their role as a volunteer makes a difference. Volunteers may offer to run an errand so a caregiver can have more time with their loved one; they may listen to a patient’s life stories, engage in conversation, play a game, help with a task, or be a quiet presence so someone doesn’t have to be alone. I have had the pleasure of hearing and witnessing many beautiful stories about the connections that happen between our volunteers and patients. I am honored to work with such an amazing organization and people!”

Why I Work in Hospice (Part 2) – Suzy Quinones, Hospicare RN

Posted on by Hospicare

A Special Blog Series in Honor of National Hospice and Palliative Care Month

This November, we are sharing a special blog series written by Hospicare staff in honor of National Hospice and Palliative Care Month. Each post will feature a different member of our staff as they share why they love the work they do. In part two of this series, we feature Suzy Quinones, Hospicare RN.

Suzy Quinones, Hospicare RN

“My role here at Hospicare is to help patients live the rest of their lives as comfortably as possible and to help ensure their wishes are fulfilled. Providing education and suggestions for patients and their families about how best to meet that patient’s specific needs and how to manage their symptoms adequately. Every patient is different, so I like to customize my care to best fit each patient’s needs and wishes.

At Hospicare, we really try to meet people ‘where they are’ and adjust to their needs accordingly as time goes on. To help make this possible, collaboration with other members of the Hospicare team is essential. Our team is made up of social workers, bereavement specialists, our medical director, spiritual care, volunteers and so many others that help keep our patients safe and comfortable.

Death is commonly seen as a scary thing, but it doesn’t have to be. I try to make death a beautiful transition for patients and their families by doing anything I can to support them physically and emotionally during this time. I feel very blessed that patients allow me to accompany them on this journey.”

Why I Work in Hospice (Part 1) – Kimmy Jones, Clinical Team Leader

Posted on by Hospicare

A Special Blog Series in Honor of National Hospice and Palliative Care Month

This November, we are sharing a special blog series written by Hospicare staff in honor of National Hospice and Palliative Care Month. Each post will feature a different member of our staff as they share why they love the work they do. In part one of this series, we feature Kimmy Jones, RN and Clinical Team Leader.

Kimmy Jones, RN, Clinical Team Leader

“Hello, I’m Kimmy. I’m the clinical team leader for Hospicare which means I supervise the primary nurses, LPNs, and home health aides in the field. Most of the patients we serve are in the field, living in a private home or a facility within Tomkins or Cortland counties. I’ve been an RN for 16 years and hospice work is the most meaningful nursing care I’ve ever done. It’s sacred work. I started my nursing career in the emergency department, then I worked in lactation education and breastfeeding/chest feeding support, and now I work in hospice.

I started here at Hospicare a little over three years ago as a primary nurse. After a year, I moved into the team leader position. This move just happened to take place right before the discovery of the Covid-19 virus. We have continued to serve the community and our patients throughout the entirety of the Covid-19 pandemic and to be diplomatic, it’s been quite a learning experience. The reason we have been successful during this time is our outstanding team of devoted staff members. Everyone has their heart focused on the mission to continue to care for our community, which has allowed us to forge through the uncertainty and ever-changing landscape of nursing care that has been brought on by this pandemic.

Hospice work can be very emotionally taxing. It can even be heartbreaking. But it’s some of the most rewarding and special work I’ve ever done. We are invited into people’s homes during a very sacred and intimate time, and it is such an honor. It feels fulfilling to be able to alleviate distress, whether that’s physical or emotional, and for the patient and family to trust us and look to us for guidance and reassurance. You’ll be hard pressed to find any healthcare worker who doesn’t find that rewarding. 

When asked ‘What brought you to work in hospice?’, a lot of people have beautiful stories about a personal experience they had when a loved one received hospice. I don’t have a story like that. For me, it just felt good. It felt right.”

How to Make Death Binder – A Gift to Your Loved Ones

Posted on by Hospicare

What is a Death Binder?

A death binder is a place to gather necessary information and documents that detail how we want our wishes carried out, our belongings dispersed, our finances dealt with, etc.

A homemade Death Binder puts all your important documents in one place.

Why make a death binder?

Reasons include:

  • It’s a gift to our loved ones: reduces the stress for our families when confronted with difficult medical decisions or in the event of our death
  • Provides a concrete plan for our family to follow; no surprises
  • Provides the opportunity for  family and friends to provide a loving presence at your bedside and emotional support for one another
  • A gift to ourselves: a chance for us to review our lives and even make changes
  • Provides the opportunity for us to have  difficult conversation with our family, hopefully alleviating charged conversations later
  • Provides the opportunity for family to become closer

STEP ONE – Set your Intention

Set the intention and ask your self the hard questions about your life and your choices.

  • How do you imagine your end-of-life experience?
  • What medical or life-sustaining care do you want?
  • Who are the family and friends who will be most impacted by your death? 
  • What do you want your legacy to be?

STEP TWO – Gather your Documents

Gather important information and documents that we want to be readily available in case of natural disaster, medical emergency, or death.

Download our FINDING THE DOCUMENTS YOU NEED worksheet.

Here’s a start to your list:

  • Medical Documents
  • Bank account numbers, both checking and savings 
  • Insurance policies 
  • Investment account details 
  • Safe deposit box keys
  •  Social security card and other identification like birth certificates and passports
  • Utility and other monthly billing information
  • Mortgage, deed, or lease for your home or residence
  • Vehicle title
  • Internet account numbers and passwords, including subscriptions and email accounts
  • Important phone numbers for family members, your lawyer, doctor, and financial planner, pastor or priest, and your preferred funeral home. ??

A document like “5 Wishes” can help you think about medical, emotional and spiritual questions, providing a structure for you to reflect on these issues and start the conversation with your health care proxy, other medical providers, and your family. 

STEP THREE – Organize your Documents

Decide what would work best for you. You can put documents in a binder, file cabinet, or box. If you make your own so that you can customize it to be an expression of you and your values. Or you can purchase one on the internet or at a local book store.

Poke around and see what makes the most sense for you!

This homemade Death Binder includes handwritten tabs for organizing documents.
There are several premade options on the internet. Such as printables, fill as you go workbooks, and books.

STEP FOUR – Have the Conversations

The next step is to talk to your loved ones and let them know what you are doing and why it’s important.

Although end-of-life planning is critical for adults at every age, it can be difficult to find a way to introduce the topic of conversation to your loved ones.

Possible conversation starters:

  • There’s been something on my mind and now is a good time to bring it up
  • You can count on me to be there for you
  • I want to do the right things for you when you need them the most
  • I don’t know your wishes so please tell me them so I can honor them whether I agree with them or not
  • You matter to me and I care about you

Remember, a Death Binder is a living document and should be updated regularly. We live in a death phobic culture and it can be difficult to prioritize getting our affairs in order, it is a gift to yourself and your loved ones. 

Please don’t hesitate to reach out if you have any questions. Email us or call 607-272-0212.